Natural outcomes of stage 1, 2, 3, and 4 idiopathic macular holes.

AIMS A study was carried out to ascertain the natural outcome of each stage of idiopathic macular hole. METHODS One hundred and fifty four eyes with different stages of idiopathic macular holes were retrospectively studied: stage 1 (40 eyes), 2 (25 eyes), 3 (58 eyes), and 4 (31 eyes). RESULTS Of 27 of 40 eyes with a stage 1 lesion with posterior vitreous attachment to the macula initially, nine (33%) eyes developed a full thickness macular hole. No stage 1 lesions with posterior vitreous separation from the macula initially progressed to full thickness holes. Twenty one (84%) of 25 eyes with a stage 2 lesion, 32 (55%) of 58 eyes with a stage 3 lesion, and five (16%) of 31 eyes with a stage 4 lesion underwent macular hole enlargement during the median follow up period of 3 years. Visual acuity decreased two or more lines of Snellen equivalent during the follow up period in 12 (30%) eyes with a stage 1 lesion, 17 (68%) eyes with a stage 2 lesion, 17 (29%) eyes with a stage 3 lesion, and four (13%) eyes with a stage 4 lesion. The percentage was significantly higher in eyes with stage 2 lesions than the other stages (p < 0.01). CONCLUSION The results suggest that the different stages of idiopathic macular holes have different natural outcomes, and the management depends on the stage at presentation.